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Impact of maternal antidepressant therapy on maternal and child outcomes: a data linkage study

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  • Full or part time
    Prof Reynolds
    Dr Denison
  • Application Deadline
    No more applications being accepted
  • Awaiting Funding Decision/Possible External Funding
    Awaiting Funding Decision/Possible External Funding

Project Description

Supervisors: Professor Rebecca Reynolds, Dr Fiona Denison
Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health

Perinatal depression is common [1], costs the UK £8.1 billion/year [2], and has long-term adverse consequences on maternal and child health [3-5]. Despite this there are limited treatment options available other than drug therapy. The long-term safety for the offspring of common drugs used to treat depression is not known, with some evidence that antidepressant drug use in pregnancy is associated with adverse neurodevelopmental outcomes in the offspring [6-8]. Although the National Institute of Health and Clinical Excellence Guidelines underlines that antidepressant drugs should be prescribed cautiously for women planning pregnancy [9], the consequences for women who discontinue therapy during pregnancy is profound, with increased risk of relapse of their underlying disease in the post-partum period and associated adverse consequences for both maternal and child health.

This PhD project offers the exciting opportunity to determine the consequences of antidepressant use during pregnancy on maternal and offspring outcomes by analysing linked population level data which is uniquely available in Scotland. The project is timely due to i) the increasing awareness of the problem of maternal depression during pregnancy [2], ii) improving maternal mental health is top priority for the Scottish Government [10], iii) the supervisors have established links with the Farr Institute (http://www.farrinstitute.org/) in Edinburgh allowing excellent training to execute the project, iv) In Scotland there is a unique opportunity to link national GP prescribing data for antidepressant medicines during pregnancy to maternity health records and offspring outcomes using the unique patient identifier, the CHI number. This will create a rich dataset with key information that is not available in other databases such as details about estimated drug doses, gestation that the medication is prescribed, and whether the prescription is collected at the pharmacy. Interrogation of the linked dataset will allow the student to answer important unknown questions about drug safety, efficacy and pregnancy outcomes in women prescribed antidepressant medicines in pregnancy.

The student will create a dataset linking prescriptions for antidepressant medicines in pregnancy with maternity and child health care records in order to determine the:

1. prevalence of use of antidepressant medicines in pregnancy in Scotland
2. gestation of prescription and potential duration of drug exposure to the fetus
3. pregnancy outcomes: birthweight, gestation at delivery, congenital anomaly, neonatal mortality, stillbirth
4. longer term offspring outcomes e.g. obesity, educational outcomes, hospital admissions

Analyses will include adjustment for potential confounders including maternal age, parity, deprivation category, ethnicity, body mass index, pre-existing disease, mode of delivery and pregnancy complications.

The successful student will train at a world-leading centre in maternal and reproductive health. The supervisors have an established record of research in mental health in pregnancy [5, 11-15]. The student will receive training in quantitative skills using health records: statistics, computation skills, ‘big’ data handling, digital excellence and research ethics. The student will be encouraged to present the research at national and international conferences, and, with our guidance, to publish in peer-reviewed journals. By identifying which antidepressant medications are/are not associated with adverse maternal and child outcomes, the project will potentially impact public health policy and clinical practice.

The Little France Campus
The MRC Centre for Reproductive Health (CRH) is located on the ground floor of the Queen’s Medical Research Institute on the University of Edinburgh’s Medical Campus at Little France. The MRC CRH enjoys close collaborative links with the other Centres on the Little France Campus including the MRC Centre for Inflammation Research (MRC-CIR); the British Heart Foundation Centre of Excellence in Cardiovascular Science (BHF-CVS), the Clinical Research Imaging Centre (CRIC) and the MRC Centre for Regenerative Medicine (CRM). The campus has a thriving postgraduate community.

www.crh.ed.ac.uk

Applicants are expected to have a good honours degree in the sciences (biological, chemical or physical), at least UK level of 2.1 or the equivalent from non-UK universities. A Master’s degree in a relevant subject would be an advantage.

How to apply?
Please submit a CV through the Admissions Enquiries form below.
A ‘statement of purpose’/personal statement and details of 3 academic referees will also be requested.
Application deadline 15 February 2016.

Interviews are expected to take place during early March 2016, the successful applicant beginning studies in September/October 2016, providing funding has been secured.

Funding Notes

The 3 year MRC funded studentships are open to outstanding UK science graduates wishing to pursue a career in Reproductive Health. The studentship will cover fees at the UK/EU rate and a minimum stipend as directed by the MRC.

This research project will be in direct competition with 7 other projects currently on offer at the MRC-CRH. Usually the project with the best applicant/s will be awarded the funding. The funding is available to UK graduates who can demonstrate ordinary residence in the UK as defined at through the link below.
www.mrc.ac.uk/skills-careers/studentships/studentship-guidance/student-eligibility-requirements/

References

1. Gavin N, Gaynes B, Lohr K. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynaecol. 2005;106(5):1071–83.
2. Bauer A, Parsonage M, Knapp M, Lemmi V, Adelaja B. The costs of perinatal mental health problems. London School of Economics and Political Science. 2014. http://www.centreformentalhealth.org.uk/pdfs/Costs_of_perinatal_mh.pdf.
3. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D. Maternal Depression and Child Psychopathology: A Meta-Analytic Review. Clin Child Fam Psychol Rev. 2011;14(1):1–27.
4. Loomans EM, van Dijk AE, Vrijkotte TGM, van Eijsden M, Stronks K, Gemke RJBJ, et al. Psychosocial stress during pregnancy is related to adverse birth outcomes: results from a large multi-ethnic community-based birth cohort. Eur J Public Health. 2013;23(3):485–91.
5. Mina TH, Reynolds RM. Mechanisms Linking In Utero Stress to Altered Offspring Behaviour. In: Pariante CM, Lapiz-Bluhm MD, editors. Behavioural Neurobiology of Stress-related Disorders. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014. p. 93–122.
6. El Marroun H, White T, Verhulst FC, Tiemeier H. Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: a systematic review. Eur Child Adolesc Psychiatry 2014; 23(10): 973-92
7. El Marroun H, White TJ, van der Knaap NJ, Homberg JR, Fernandez G, Shoemaker NK, Jaddoe VW, Hofman A, Verhulst FC, Hudziak JJ, Sticker BH, Tiemeier H. Prenatal exposure to selective serotonin reuptake inhibitors and social responsiveness symptoms of autism: population-based study of young children. Br J Psychiatry 2014; 205(2): 95-102
8. Previti G, Pawlby S, Chowduhry S, Aguglia E, Pariante C. Neurodevelopmental outcome for offspring of women treated for antenatal depression: a systematic review. Arch Womens Ment Health 2014; 17(6): 471-83
9. NICE, NICE Guideline CG192: Antenatal and postnatal mental health: clinical management and service guidance, 2014
10. http://www.maternal-and-early-years.org.uk/topic/pregnancy/mental-health-and-wellbeing-in-pregnancy


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FTE Category A staff submitted: 206.93

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